Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to identify factors that might help differentiate phyllodes tumors from fibroadenomas among cases in which a fibroepithelial breast lesion was diagnosed from core needle biopsy (CNB) under imaging guidance. MATERIALS AND METHODSA retrospective review was performed on 213 lesions in 200 patients who had undergone both CNB and excisional biopsy during a four-year period between 2008 and 2011. The final pathology revealed 173 fibroadenomas and 40 phyllodes tumors. The data, including patient characteristics, clinical presentation, and mammography, ultrasonography (US), and pathology findings were analyzed. RESULTSUpon univariable analysis, the factors that significantly helped to identify phyllodes tumors consisted of the presenting symptoms (palpable mass or breast pain), increased size on clinical examination, hyperdense mass on mammogram, and the following three US features: heterogeneous echo, presence of round cysts within the mass, and presence of clefts within the mass. The pathologist's suggestion of a phyllodes tumor was also helpful. The factors that remained statistically significant upon multivariable analysis consisted of symptoms of breast pain, the presence of clefts on US, the presence of round cysts on US and the pathologist's favoring of phyllodes tumors from a CNB specimen. CONCLUSION A multidisciplinary approach was needed to distinguish phyllodes tumors from fibroadenomas in patients who had undergone CNB. US findings (clefts and round cysts), suggestive pathological diagnoses, and clinical symptoms were all useful for the decision to surgically remove the fibroepithelial lesions diagnosed from CNB.

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features

“…High density was reported to be a useful mammographic feature suggestive of phyllodes tumors due to the larger lesion size [5,9,13], although this was not a significant finding in the present study. Previous studies yielded contradictory results regarding the presence or absence of intratumoral calcifications.…”

“…Previous studies yielded contradictory results regarding the presence or absence of intratumoral calcifications. Some studies indicated that fibroadenomas, especially long-standing lesions, more frequently contained calcifications [16] while others indicated no difference in frequency, as in the present study [5,9]. …”

“…The distinction between phyllodes tumor and fibroadenoma is clinically important, as approximately 20-30% of resected phyllodes tumors are malignant [1], and approximately 25% of malignant phyllodes tumors metastasize [4]. Phyllodes tumors must be treated surgically while fibroadenomas can be followed up safely without further investigation or can be treated with simple enucleation [5]. Moreover, wide excision of all types of phyllodes tumors with adequate margins is essential to avoid local recurrence and subsequent surgery [6,7,8], as the local recurrence rates of benign and borderline tumors are 20 and > 25%, respectively [4].…”

Клінічні Особливості Імуногістохімічної Діагностики Сарком Та Філоїдних Пухлин Грудної Залози

“…ФП є складними для діагностики утвореннями, що мають непередбачуваний прогноз, схильність до рецидивування та злоякісного переродження. Важливо диференціювати ФП та фібро-аденоми, які є найпоширенішим утворенням грудної за-лози [17], оскільки існують істотні відмінності в лікувальній тактиці щодо цих утворень. У випадку фібро аденоми до-пустимою є вичікувальна тактика та вилущення пухлини, що є абсолютно недопустимим у випадку ФП та СГЗ [18].…”

Radiologic and histopathologic review of rare benign and malignant breast diseases

“…Discrimination of fibroadenomas from phyllodes tumors cannot be made by US or mammography. However, phyllodes tumor should be kept in mind, particularly in the presence of clefts or round cysts within solid masses on US (21). Fig.…”